The Fat Positive Lounge

[Toughy]

Originally Posted by 1QuirkyKiwi

Thank you!

<snip>

A recent trend here is GPs being Fat phobic and using it as a prognosis for a person’s ill health. They have targets to meet on certain health issues; for every target they achieve they receive a large sum of money. Healthcare here has changed for the worst.

Back home, we have a 3 tier health system with those who can’t afford health care being subsidised.

<snip>

What you are saying about how GPs are paid is not really true. Here is a link that explains how docs in the UK are being paid under the new contract.

http://www.bma.org.uk/press_centre/p...p#.T2jtiBHy_Qg

How general practice is funded

Almost all funding in the current contract is practice-based. This means that payments are made to the practice and not to individual GPs. Expenses - for example, rent, utility bills and staff wages - are taken out of this funding pot and the amount remaining, after the cost of providing clinical services has been taken out, makes up the pay available to the GP partners.

The funding formula is extremely complex and funding is distributed to practices according to the weighted needs of their population - for example a practice with a large elderly population, and therefore a greater workload, will get more funding than a practice with a relatively young, healthy population.

GP practices receive their funding through several major streams, though the main ones are the Global Sum, the Quality and Outcomes Framework (QOF), and Enhanced Services:

Here is an abstract from Health Affairs (www.healthaffairs.org)

Quality Incentives: The Case Of U.K. General Practitioners
Peter C. Smith and Nick York

Abstract

The United Kingdom is implementing major changes to the national contract for general practitioners (GPs). A central plank of the new arrangements is an ambitious scheme to reward high-quality care. Each general practice will be scored on 146 performance indicators according to the measured quality of care it delivers, and its accumulated score will determine the magnitude of the quality payment it receives. About 18 percent of practice earnings will be at risk. This paper describes the incentive scheme, discusses its potential benefits and risks, and draws out the implications for evaluation.

One of the things that has happened under this new contract is the significantly increased number of folks being diagnosed with diabetes. It has been written up in several medical journals.




It is my understanding that New Zealand has a two-tiered payment system, although I have not done recent research on their system. (I lived in NZ in early 2000 and received health care there...)



There are plenty of inaccuracies about how nationalized health care works in other countries being said in the US. I just hate seeing more put out there.

[1QuirkyKiwi]

Originally Posted by Toughy

What you are saying about how GPs are paid is not really true. Here is a link that explains how docs in the UK are being paid under the new contract.

http://www.bma.org.uk/press_centre/p...p#.T2jtiBHy_Qg

How general practice is funded

Almost all funding in the current contract is practice-based. This means that payments are made to the practice and not to individual GPs. Expenses - for example, rent, utility bills and staff wages - are taken out of this funding pot and the amount remaining, after the cost of providing clinical services has been taken out, makes up the pay available to the GP partners.

The funding formula is extremely complex and funding is distributed to practices according to the weighted needs of their population - for example a practice with a large elderly population, and therefore a greater workload, will get more funding than a practice with a relatively young, healthy population.

GP practices receive their funding through several major streams, though the main ones are the Global Sum, the Quality and Outcomes Framework (QOF), and Enhanced Services:

Here is an abstract from Health Affairs (www.healthaffairs.org)

Quality Incentives: The Case Of U.K. General Practitioners
Peter C. Smith and Nick York

Abstract

The United Kingdom is implementing major changes to the national contract for general practitioners (GPs). A central plank of the new arrangements is an ambitious scheme to reward high-quality care. Each general practice will be scored on 146 performance indicators according to the measured quality of care it delivers, and its accumulated score will determine the magnitude of the quality payment it receives. About 18 percent of practice earnings will be at risk. This paper describes the incentive scheme, discusses its potential benefits and risks, and draws out the implications for evaluation.

One of the things that has happened under this new contract is the significantly increased number of folks being diagnosed with diabetes. It has been written up in several medical journals.




It is my understanding that New Zealand has a two-tiered payment system, although I have not done recent research on their system. (I lived in NZ in early 2000 and received health care there...)



There are plenty of inaccuracies about how nationalized health care works in other countries being said in the US. I just hate seeing more put out there.

My cousin works for the same NHS I’m talking about and has done for many years. He has known of the financial incentives being paid to GPs. Several Locum Doctors have been prosecuted in recent years for misusing funds.

In NZ Primary Care (GPs) and medications on the list of the New Zealand government agency require co-payments, but are subsidised, especially for patients with community health services cards or high user health cards; low income families and the disabled. Surgeries and other medical treatments are paid for by health insurance schemes for members privately. Those that can be for treatment, do.

[Toughy]

Me in this color

Originally Posted by 1QuirkyKiwi

My cousin works for the same NHS I’m talking about and has done for many years. He has known of the financial incentives being paid to GPs. Several Locum Doctors have been prosecuted in recent years for misusing funds.

This statement is different from your original statement. Fraud exists in every health care system and is a very small percentage of the cost of health care. There are fraud task forces in the UK that address that issue. It's not some huge percentage of GPs that commit fraud. It's more like several as you said. If I remember correctly, in the entire US, the large overwhelmingly majority of fraud is committed by less than 100 clinicians.

In NZ Primary Care (GPs) and medications on the list of the New Zealand government agency require co-payments, but are subsidised, especially for patients with community health services cards or high user health cards; low income families and the disabled. Surgeries and other medical treatments are paid for by health insurance schemes for members privately. Those that can be for treatment, do.

My picky point was you said a 3 tiered system. My understanding (and what you describe) is a two-tiered system. What you describe is pretty much the same as it was when I lived there. I had co-pays for both primary care and prescriptions and all I payed was the co-pay. I thought overall I received great care in NZ.

As I said I hate inaccuracies. Anyway....back to the fat positive talk

[1QuirkyKiwi]

Originally Posted by Toughy

Me in this color




As I said I hate inaccuracies. Anyway....back to the fat positive talk

No disrespect intended in this discussion; having been raised in NZ and living in the UK for the past 5 years my statements are not inaccurate. They are based on my own knowledge and experience as well of that of my cousin, as I mentioned before.

He has asked several of the Doctors he works with, how the system ‘really works’ and not what is detailed on the internet.

[Toughy]

Originally Posted by 1QuirkyKiwi

No disrespect intended in this discussion; having been raised in NZ and living in the UK for the past 5 years my statements are not inaccurate. They are based on my own knowledge and experience as well of that of my cousin, as I mentioned before.

He has asked several of the Doctors he works with, how the system ‘really works’ and not what is detailed on the internet.

I do believe the British Medical Association.....they negotiated the contract with the government on behalf of doctors..........is a highly reputable organization. What they say is factual.

Health Affairs is the leading journal of health policy thought and research. The peer-reviewed journal was founded in 1981 under the aegis of Project HOPE, a nonprofit international health education organization. Health Affairs explores health policy issues of current concern in both domestic (US) and international spheres.

Neither of my references are from just any place on the net. Both are highly respected and are factual. Your opinion is not fact.....no disrespect intended.

[1QuirkyKiwi]

Originally Posted by Toughy

I do believe the British Medical Association.....they negotiated the contract with the government on behalf of doctors..........is a highly reputable organization. What they say is factual.

Health Affairs is the leading journal of health policy thought and research. The peer-reviewed journal was founded in 1981 under the aegis of Project HOPE, a nonprofit international health education organization. Health Affairs explores health policy issues of current concern in both domestic (US) and international spheres.

Neither of my references are from just any place on the net. Both are highly respected and are factual. Your opinion is not fact.....no disrespect intended.

On this matter, it’s best if we just agree to disagree! …And as you say; back to the fat positive talk.

[ButchEire]

I have to speak to this, as a person with their name on several published research studies. Kiwi is correct, or rather her cousin is. The system at large, in the United States and from what she said, in the UK and NZ IS driven by funding, not finding. Statistics can be contorted and distorted to fit any argument and unfortunately, that is typically the case.

Originally Posted by 1QuirkyKiwi

No disrespect intended in this discussion; having been raised in NZ and living in the UK for the past 5 years my statements are not inaccurate. They are based on my own knowledge and experience as well of that of my cousin, as I mentioned before.

He has asked several of the Doctors he works with, how the system ‘really works’ and not what is detailed on the internet.

Originally Posted by Toughy

I do believe the British Medical Association.....they negotiated the contract with the government on behalf of doctors..........is a highly reputable organization. What they say is factual.

Health Affairs is the leading journal of health policy thought and research. The peer-reviewed journal was founded in 1981 under the aegis of Project HOPE, a nonprofit international health education organization. Health Affairs explores health policy issues of current concern in both domestic (US) and international spheres.

Neither of my references are from just any place on the net. Both are highly respected and are factual. Your opinion is not fact.....no disrespect intended.

[Toughy]

Big whoopeee you are an author on published papers.............so am I.

This is NOT fat positive based and let's not derail this thread anymore.